Patient satisfaction after elective implant removal of the lower extremity - a retrospective cohort study.

PURPOSE: The topic of elective implant removal (IR) in healed fractures of the lower extremity remains controversial, particularly when unspecific symptoms of discomfort, which cannot be quantified, are the primary indication. This study aims to assess indications and outcomes of elective IR of the lower extremity, focusing on unspecific symptoms of discomfort and patient satisfaction postoperatively. MATERIALS AND METHODS: The retrospective cohort study was conducted at a single level I academic trauma center. We included patients who underwent elective IR for healed fractures of the ankle, foot, patella, and proximal tibia from 2016 to 2021. All patients were followed-up for a minimum of 6 weeks after IR. Our outcomes of interest were patient satisfaction, complications, and alleviation of complaints. RESULTS: A total of 167 patients were included in the study. Unspecific symptoms of discomfort were the most common reason for IR in all investigated anatomical regions of the lower extremity (47.9%), followed by pain (43.1%) and limited range of motion (4.2%). 4.8% of patients experienced a combination of pain and range of motion limitation. Among all patients, 47.9% reported subjective improvement after IR. IRs based on unspecific symptoms of discomfort were significantly less likely to show alleviation of complaints after IR (27.5%, OR 0.19, p ≤ 0.01). Patients who reported limited range of motion (OR 1.7, p = 0.41) or pain (OR 6.0, p = 0) were significantly more likely to be satisfied after IR. Patients who reported sensitivity to cold weather also showed a decrease of complaints after IR (OR 3.6, p = 0.03). Major complications occurred in 2.1% of cases. The minor complication rate was 8.4% (predominantly impaired wound healing). Smoking patients showed a significantly higher risk of complications after IR (OR 5.2, p = 0.006). Persistent pain postoperatively was detected in 14.7%. CONCLUSION: When elective IR for consolidated fractures of the lower extremity is primarily motivated by patients' subjective symptoms of discomfort, the risk for postoperative dissatisfaction significantly increases. Objective symptoms on the other hand are associated with higher satisfaction after IR. While the procedure is generally safe, minor complications such as wound healing disorders can occur, especially in smokers. Patient education and well-documented informed consent are critical.

The impact of fasciotomy on inpatient outcomes in lower leg fracture management.

BACKGROUND: While lower extremity fractures are common injuries, concomitant compartment syndrome can lead to significant implications and surgical release (fasciotomy) is essential. The aim of this study was to identify potential predictors of compartment release and risk factors related to complications. Using a large nationwide cohort, this study compared patients suffering from lower extremity fractures with and without compartment syndrome during their primary in-hospital stay following trauma. METHODS: A retrospective analysis was conducted using the prospective surgical registry of the working group for quality assurance in surgery in Switzerland, which collects data from nearly 85% of all institutions involved in trauma surgery. Inclusion criteria Patients who underwent surgical treatment for tibia and/or fibula fractures between January 2012 and December 2022 were included in the study. Statistics Statistical analysis was performed using Chi-square, Fisher's exact test, and t test. Furthermore, a regression analysis was conducted to determine the independent risk factors for fasciotomy and related complications. In the present study, a p value less than 0.001 was determined to indicate statistical significance due to the large sample size. RESULTS: The total number of cases analyzed was 1784, of which 98 underwent fasciotomies and 1686 did not undergo the procedure. Patients with fasciotomies were identified as significantly younger (39 vs. 43 years old) and mostly male (85% vs. 64%), with a significantly higher American Society of Anesthesiologists (ASA) score (ASA III 10% vs. 6%) and significantly more comorbidities (30% vs. 20%). These patients had significantly longer duration of surgeries (136 vs. 102 min). Furthermore, the total number of surgical interventions, the rate of antibiotic treatment, and related complications were significantly higher in the fasciotomy group. Sex, age, comorbidities, and fracture type (both bones fractured) were identified as relevant predictors for fasciotomy, while ASA class was the only predictor for in-hospital complications. Outcomes Patients who underwent fasciotomy had a significantly longer hospital stay (18 vs. 9 days) and a higher complication rate (42% vs. 6%) compared to those without fasciotomy. While fasciotomy may have played a role, other factors such as variations in patient characteristics and injury mechanisms may also contribute. Additionally, in-house mortality was found to be 0.17%, with no patient death recorded for the fasciotomy group. CONCLUSIONS: Fasciotomy is vital. The knowledge about the further course is, however, helpful in resource allocation. We found significant differences between patients with and without fasciotomy in terms of age, sex, complication rate, length of stay, comorbidities, duration of operations, and use of antibiotics during their primary in-hospital stay. While the severity of the underlying trauma could not be modulated, awareness of the most relevant predictors for fasciotomy and related complications might help mitigate severe consequences and avoid adverse outcomes.

Elective implant removal in the upper extremity: only symptomatic patients benefit.

PURPOSE: Elective implant removal (IR) in the upper extremity remains controversial. Implants in the olecranon and clavicle are commonly removed for prominence, unlike in the distal radius. Patient-reported symptomatic cannot be verified, and nonspecific discomfort remains unquantified. In this study, indications and outcomes of IR at the clavicle, olecranon and distal radius were evaluated, with a focus on postoperative patient satisfaction. MATERIALS AND METHODS: In this retrospective, single-center cohort study, patients, who received elective IR of the clavicle, olecranon and distal radius were included. Patients were followed up at least six weeks after IR. Outcomes included patient satisfaction, symptom resolution, and complications. RESULTS: One hundred and eighty-nine patients were included. Unspecific symptoms of discomfort were the most prevalent indication for IR (48.7%), followed by pain (29.6%) and objective limited range of motion (ROM) (7%). Pain and limited ROM combined was observed in 13.8%. Subjective benefit following IR was described in 54%. Patients with limited ROM (OR 4.7, p < 0.001) or pain (OR 4.1, p < 0.001) were more likely to experience alleviation of complaints. Patients with unspecific symptoms of discomfort, often did not report improvement. Major complications occurred in 2%. Refractures were detected at the clavicle (3.7%) and at the olecranon (2.5%). Minor complication rate was 5%. CONCLUSION: IR is a safe procedure in the upper extremity. Indications based on unspecific symptoms of discomfort have a significant lower rate of patient satisfaction postoperatively. Elective IR should be considered cautiously, if it is driven primarily by unspecific symptoms of discomfort. Patient education is relevant to prevent dissatisfying outcome.

[Bilateral thoracic trauma-"double the trouble"?] / Beidseitiges Thoraxtrauma ­ "double the trouble"?

BACKGROUND: Thoracic trauma is associated with a high morbidity and mortality. Assessing the risk for complications is essential for planning the further treatment strategies and managing resources in thoracic trauma. OBJECTIVE: The aim of the study was to analyze concomitant injuries in unilateral and bilateral rib fractures and pulmonary contusions and evaluate differences in complication rates between the two. MATERIAL AND METHODS: In a retrospective study, data from all patients diagnosed with thoracic trauma at a level I trauma center were analyzed. Bivariate and multivariate analysis were used to examine an association of unilateral or bilateral rib fractures, serial rib fractures, and pulmonary contusions with multiple injuries and outcomes. In addition, multivariate regression analysis was utilized to determine the impact of age, gender and additional injuries on outcome. RESULTS: A total of 714 patients were included in the analysis. The mean Injury Severity Score (ISS) was 19. Patients with an additional thoracic spine injury had a significantly higher incidence of bilateral rib fractures. Pulmonary contusions were associated with younger age. Abdominal injuries were predictors for bilateral pulmonary contusions. Complications occurred in 36% of the patients. Bilateral injuries increased the complication rate up to 70%. Pelvic and abdominal injuries as well as the need for a chest drain were significant risk factors for complications. The mortality rate was 10%, with higher age, head and pelvic injuries as predictors. CONCLUSION: Patients with bilateral chest trauma had an increased incidence of complications and a higher mortality rate. Bilateral injuries and significant risk factors must therefore be considered. Injury of the thoracic spine should be excluded in those patients.

Does the type of anesthesia (regional vs. general) represent an independent predictor for in-hospital complications in operatively treated malleolar fractures? A retrospective analysis of 5262 patients.

PURPOSE: The impact of the type of anesthesia (regional vs. general anesthesia) on in-hospital complications in ankle fractures has not been thoroughly studied yet. Identifying factors that place patients at risk for complications following ankle fractures may help reduce their occurrence. The primary goal of this study was (1) to describe the cohort of patients and (2) to evaluate independent risk factors for complications during hospitalization. METHODS: We analyzed patients from 2005 to 2019 with an operatively treated isolated fracture of the medial or lateral malleolus using a prospective national quality measurement database. Patients were selected based on international classifications (ICD) and national procedural codes (CHOP). Uni- and multivariate analysis were applied. RESULTS: In total, we analyzed 5262 patients who suffered a fracture of the malleolus; 3003 patients (57%) had regional and 2259 (43%) general anesthesia. Patients with regional anesthesia were significantly older (51 vs. 46 years), but healthier (23 vs. 28% comorbidities) than patients who received general anesthesia. The in-hospital complication rate was not significantly lower in regional anesthesia (2.2% vs 3.0%). The type of anesthesia was not an independent predictor for complications while controlling for confounders. CONCLUSION: Type of anesthesia was not an independent predictor of complications; however, higher ASA class, age over 70 years, fracture of the medial versus lateral malleolus, longer preoperative stay, and duration of surgery were significant predictors of complications. Patient and procedure characteristics, as well as changes in medical care and epidemiological changes along with patient requests, influenced the choice of the type of anesthesia.

An outbreak of visna-maedi in a flock of sheep in Southern Brazil.

Visna-maedi is a multisystemic and progressive inflammatory disease caused by a non-oncogenic retrovirus (Visna-maedi virus, VMV). An outbreak of visna-maedi occurred in Southern Brazil in sheep with clinical signs of blindness and stumbling gait. At post-mortem examination, all animals had similar lesions, including heavy non-collapsed lungs and multifocal yellow areas in the cerebral white matter, affecting mainly the periventricular region. These lesions corresponded histologically to lymphocytic interstitial pneumonia and histiocytic periventricular encephalitis surrounding areas of necrosis, in addition to significant demyelination in the brain. Serology was performed in all the sheep from the flock and 14% were seropositive for VMV. The presence of VMV was confirmed through PCR and partial sequencing of the 5'LTR. Sequencing demonstrated that the virus had 89.7 to 90.0% of nucleotide identity with VMV strains reported in the USA. This is the first description of clinical disease related to VMV in Brazil leading to economic losses. This study calls for the need to implement control measures to prevent the spread of small ruminant lentiviruses in Brazil.

Impact of the first COVID-19 shutdown on traumatological patient volumes in Switzerland.

Background: The coronavirus has caused a worldwide pandemic with serious impacts on our healthcare systems. Many countries experienced a decline in traumatological patient volume. The aim of this study is to evaluate the impact of the first lockdown on traumatological patient volume in Switzerland. Methods: We retrospectively used a prospective national quality measurement database. We compared the period of the first lockdown in Switzerland from March 17 to April 26, 2020 to the same period in the years 2018 and 2019. Included were all adult patients with any S-code (trauma) according to the International Classification of Diseases. Results: In total, we assessed 3874 patients (1779 in the year 2018, 1303 in the year 2019, and 792 in the year 2020) with a mean age of 61 ± 21 years. The patients during the lockdown period had significantly more injuries to the hip and forearm, had more comorbidities, and were more likely to have statutory insurance. During the lockdown period, more thromboembolism prophylaxis or anticoagulation was applied, and more patients needed antibiotic treatment. Conclusions: The present study demonstrated a 40-55% reduction in patient volume during the lockdown period in Switzerland compared to the previous years. The in-hospital mortality and complication rate during the lockdown period remained stable. This study suggests that in-hospital care for trauma patients in Switzerland was not substantially affected by the first lockdown.

Short-term outcome of isolated lateral malleolar fracture treatment is independent of hospital trauma volume or teaching status: a nationwide retrospective cohort study.

INTRODUCTION: In light of current discussions about centralisation and teaching in medicine, we wanted to investigate the differences in in-hospital outcomes after surgical treatment of isolated ankle fractures, taking into account high-volume centres (HVCs) and low-volume centres (LVCs) and teaching procedures. METHODS: A retrospective analysis of malleolar fractures recorded in a National Quality Assurance Database (AQC) from the period 01-01-1998 to 31-12-2018 was carried out. Inclusion criteria were isolated, and operatively treated lateral malleolar fractures (ICD-10 Code S82.6 and corresponding procedure codes). Variables were sought in bivariate and multivariate analyses. A total of 6760 cases were included. By dividing the total cases arbitrarily in half, 12 HVCs (n = 3327, 49%) and 56 LVCs (n = 3433, 51%) were identified. RESULTS: Patients in HVCs were younger (48 vs. 50 years old), had more comorbidities (26% vs. 19%) and had more open fractures (0.48% vs. 0.15%). Open reduction and internal fixation was the most common operative treatment at HVCs and LVCs (95% vs. 98%). A more frequent use of external fixation (2.5% vs. 0.55%) was reported at HVCs. There was no difference in mortality between treatment at HVCs and LVCs. A longer hospitalisation of 7.2 ± 5 days at HVCs vs. 6.3 ± 4.8 days at LVCs was observed. In addition, a higher rate of complications of 3.2% was found at HVCs compared to 1.9% at LVCs. The frequency of teaching operations was significantly higher at HVCs (30% vs. 26%). Teaching status had no influence on mortality or complications but was associated with a prolonged length of stay and operating time. CONCLUSION: We found significant differences between HVCs and LVCs in terms of in-hospital outcomes for ankle fractures. These differences could be explained due to a more severely ill patient population and more complex (also open) fracture patterns with resulting use of external fixation and longer duration of surgery. However, structural and organisational differences, such as an extended preoperative stays at HVCs and a higher teaching rate, were also apparent. No difference in mortality could be detected.

Does the insurance status influence in-hospital outcome? A retrospective assessment in 30,175 surgical trauma patients in Switzerland.

INTRODUCTION: There has been growing evidence in trauma literature that differences in insurance status lead to inequality in treatment and outcome. Most studies comparing uninsured to insured patients were done in the USA. We sought to gain further insights into differences in the outcomes of trauma patients in a healthcare system with mandatory public health coverage by comparing publicly versus privately insured patients. METHODS: We used a prospective national quality assessment database from the Arbeitsgemeinschaft für Qualitätssicherung in der Chirurgie (AQC). More than 80 surgical departments in Switzerland are part of this quality program. We included all patients in the AQC database with any S- or T-code diagnosis according to the International Classification of Diseases ICD-10 (any injuries) who were treated during the 11-year period of 2004-2014. Missing insurance status information was an exclusion criterion. In total, 30,175 patients were included for analysis. The primary outcome was in-hospital mortality. Secondary outcomes included overall and intra- and postoperative complications. Bi- and multivariate analyses were performed, adjusted for insurance status, age, sex, American Society of Anesthesiologists (ASA) physical status category, type of injury, and surgeon's level of experience. RESULTS: In total, 76.8% (n = 23,196) of the patients were publicly insured. Patients with public insurance were significantly younger (p < 0.001), more often male (p < 0.001), and in better general health according to the ASA physical status category (p < 0.001). Length of pre- and postoperative stay and the number of operations per case were similar in the two groups. Patients with public insurance had a lower mortality rate (1.3% vs. 1.9%, p < 0.001), but after adjusting for confounders, insurance status was not a predictor of mortality. Overall complication rates were significantly higher for publicly insured patients (8.4% vs. 6.2%, p < 0.001), and after adjusting for confounders, insurance status was identified as an independent risk factor for overall complications (p < 0.001). CONCLUSION: Differences exist with respect to patient and procedural characteristics: publicly insured patients were younger, more often male, and scored better on ASA physical status. Insurance status seems not to be a predictor for fatal outcome after trauma, although it is associated with complications.

Virome Characterization in Commercial Bovine Serum Batches-A Potentially Needed Testing Strategy for Biological Products.

Bovine serum has been widely used as a universal supplement in culture media and other applications, including the manufacture of biological products and the production of synthetic meat. Currently, commercial bovine serum is tested for possible viral contaminants following regional guidelines. Regulatory agencies' established tests focused on detecting selected animal origin viruses and are based on virus isolation, immunofluorescence, and hemadsorption assays. However, these tests may fail to detect new or emerging viruses in biological products. High-throughput sequencing is a powerful option since no prior knowledge of the viral targets is required. In the present study, we evaluate the virome of seven commercial batches of bovine serum from Mexico (one batch), New Zealand (two batches), and the United States (four batches) using a specific preparation and enrichment method for pooled samples and sequencing using an Illumina platform. A variety of circular replicase-encoding single-stranded (CRESS) DNA families (Genomoviridae, Circoviridae, and Smacoviridae) was identified. Additionally, CrAssphage, a recently discovered group of bacteriophage correlated with fecal contamination, was identified in 85% of the tested batches. Furthermore, sequences representing viral families with single-stranded DNA (Parvoviridae), double-stranded DNA (Polyomaviridae and Adenoviridae), single-stranded RNA (Flaviviridae, Picornaviridae, and Retroviridae), and double-stranded RNA (Reoviridae) were identified. These results support that high-throughput sequencing associated with viral enrichment is a robust tool and should be considered an additional layer of safety when testing pooled biologicals to detect viral contaminants overlooked by the current testing protocols.

The genetic diversity of "papillomavirome" in bovine teat papilloma lesions.

BACKGROUND: Papillomaviruses are small nonenveloped, circular double-stranded DNA viruses that belong to the Papillomaviridae family. To date, 29 Bos taurus papillomavirus (BPV) types have been described. Studies involving mixed BPV infections have rarely been reported in contrast to human papillomavirus (HPV), which is commonly described in numerous studies showing coinfections. Moreover, previous studies had shown that HPV coinfections increase the risk of carcinogenesis. In the present study, we used rolling-circle amplification followed by a high-throughput sequencing (RCA-HTS) approach in 23 teat papillomas from southern Brazil. RESULTS: Eleven well-characterized BPV types and 14 putative new BPV types were genetically characterized into the Xi, Epsilon and Dyoxipapillomavirus genera according to phylogenetic analysis of the L1 gene, which expands the previous 29 BPV types to 43. Moreover, BPV coinfections were detected in the majority (56.3%) of the papilloma lesions analyzed, suggesting a genetic diverse "papillomavirome" in bovine teat warts. CONCLUSIONS: The data generated in this study support the possibility that a wide range of BPV is probably underdetected by conventional molecular detection tools, and that BPV coinfections are underestimated and probably genetic diverse. Additionally, 14 new BPV types were characterized, increasing the knowledge regarding BPV genetic diversity.

Bovine leukemia viral DNA found on human breast tissue is genetically related to the cattle virus.

Bovine leukemia virus (BLV) infection is widespread in cattle and associated with B cell lymphoma. In a previous study we demonstrated that bovine leukemia viral DNA was detected in human breast tissues and significantly associated with breast cancer. Our current study aimed to determine whether BLV DNA found in humans and cattle at the same geographical region were genetically related. DNA was extracted from the breast tissue of healthy (n = 32) or cancerous women patients (n = 27) and from the blood (n = 30) of cattle naturally infected with BLV, followed by PCR-amplification and partial nucleotide sequencing of the BLV env gene. We found that the nucleotide sequence identity between BLV env gene fragments obtained from human breast tissue and cattle blood ranged from 97.8 to 99.7% and grouped into genotype 1. Thus, our results further support the hypothesis that this virus might cause a zoonotic infection.

Nighttime Cholecystectomies are Safe When Controlled for Individual Patient Risk Factors-A Nationwide Case-Control Analysis.

BACKGROUND: The aim of this study was to evaluate if the time of day a cholecystectomy was performed affects in-hospital complication rates and mortality. METHODS: A national quality measurement database was retrospectively studied. Study period was 2010 to 2017. The inclusion criteria were operatively treated cholecystitis or another benign disease of the gallbladder. Further, the time of day the operation was performed must have been documented. We defined nighttime as all interventions performed between 7PM until 6AM. A total of 11'459 patients were included. Development of any complication during hospitalization and in-hospital mortality was the main outcomes. The first part of the study was solely descriptive. In the second part, we applied a 1:1 case-control-matching. A matched group of 274 pairs were further investigated. RESULTS: Only 8.4% of the procedures were performed during nighttime. Complications occurred in 6.7% of all patients. We found twice as many complications in the nighttime group compared to the daytime group. Mortality was 0.56% during daytime and 0.52% during nighttime. In a matched-pair analysis, however, we found no significant differences in the overall mortality rate nor in the occurrence of complications when comparing day- vs. nighttime operations. CONCLUSIONS: We found twice as many complications in the nighttime group (12%) compared to the daytime group (6.1%), mainly related to patient risk factors. In contrast to common apprehension, however, nighttime cholecystectomies were not associated with higher mortality rates.

Insights into the origin and diversification of bovine viral diarrhea virus 1 subtypes.

In this study, we performed phylogenetic and evolutionary analysis on bovine viral diarrhea virus 1 (BVDV-1) sequences to investigate the origin and temporal diversification of different BVDV-1 subtypes. Dated phylogenies using the complete polyprotein sequence were reconstructed, and the time of the most recent common ancestor (tMRCA) was estimated. The results demonstrated that BVDV-1 subtypes clustered into two phylogenetic clades, where the predominant subtypes worldwide grouped together. In the temporal analysis, the tMRCA of BVDV-1 was 1336, and the diversification into different subtypes appears to have occurred around 363 years ago. The present results help to elucidate the origins of BVDV-1 subtypes and the dynamics of ruminant pestiviruses.

Appendectomy as Teaching Operation: No Compromise in Safety-An Audit of 17,106 Patients.

OBJECTIVE: In a surgical career, teaching of surgical procedures plays a central role. In this study we want to evaluate the influence of teaching in appendectomies on the in-hospital outcome. DESIGN AND SETTING: Retrospectively, 26,436 cases from the national quality measurement database (AQC) between the years 2009 and 2017 were evaluated using the diagnosis and the procedure codes. Included were all cases with appendicitis (International Classification of Diseases diagnostic codes K35-K37), surgical treatment (appendectomy), and a documented teaching status of the procedure. Variables were sought in bivariate and multivariate analyses. The occurrence of any complication was the primary outcome, whereas in-hospital mortality was the secondary outcome. PARTICIPANTS: A total of 17,106 patients with a mean age of 37 ± 19 years remained for final analysis. A total of 6267 operations (37%), were conducted as teaching-operations. Seventy-four percent of all teaching procedures were performed by residents. RESULTS: We found no statistical association between teaching operations and complication rates or mortality. However, the teaching group showed longer duration of surgery (+ 11%). CONCLUSIONS: There was no influence of the training status of the appendectomy procedure on complication rates and in-hospital mortality. However, there was a prolonged duration of surgery. Despite these statistically significant differences, a comparable clinical outcome was observed in all patients, thus justifying the benefits of resident training.

Campylobacter fetus in abomasal fluid from spontaneously aborted bovine and ovine fetuses

Pregnancy losses are a major concern in livestock industry due to their economic impact on producers. Campylobacter fetus subspecies fetus (Cff) and C. fetus subspecies venerealis (Cfv) are directly related to reproductive failures in ruminants. Cff colonizes the gastrointestinal tract of a wide range of hosts leading to abortion, while Cfv is restricted to genital tract being generally associated to infertility in bovine. Considering the great economic losses related to campylobacteriosis in cattle and ovine herds, this study aims to investigate the occurrence of C. fetus, considering Cff and Cfv subspecies, in bovine and ovine spontaneously aborted fetuses in state of Rio Grande do Sul, Brazil. In this study, samples of abomasal fluid collected from 30 spontaneously aborted bovine (n = 18) and ovine (n = 12) fetuses were investigated for the detection of Campylobacter fetus throughout conventional PCR. Positive fetuses for C. fetus presence were further analyzed by molecular assays for Cff and Cfv detection, in order to determine subspecies identification. When available, samples of the main organs of the thoracic and abdominal cavities, as well as the brain, skeletal muscle, eyelid, skin, and placenta were collected for further histopathological analyses and bacterial culture, aiming to assess the presence of infection lesions and pathogens in those sites, respectively. Additionally, RT-qPCR assays were also performed for the detection of ruminant pestivirus, in order to detect bovine viral diarrhea cases. Throughout the present methodology, C. fetus was detected in the abomasal fluid samples of 2 bovine fetuses, being both identified as Cfv subspecies by PCR. Histopathological analyses demonstrated that macroscopic and microscopic changes found in the Cfv-positive animals were not either specific or directly related to Campylobacter infections. Moreover, no significant bacterial growth was observed in microbiological culture from the collected tissues, and both fetuses were negative for ruminant pestivirus. Differently, there was no detection of C. fetus in any of the analyzed ovine fetuses. Considering that abortion diagnosis rates reported in cattle and sheep industry are highly variable among the published studies, and that abortion diagnoses are commonly inconclusive due to difficulties in sampling methodology and inadequate identification of the pathogen involved, it is important to investigate the etiological causes of abortion the herds for better understanding the causes of pregnancy issues and monitoring their occurrence. In addition, the absence of pathognomonic lesions in the tissues investigated in the histopathological analyses observed in this study strongly suggests that well-known etiological agents commonly associated to abortion, such as Leptospira spp., Toxoplasma spp., Chlamydia spp. and Neospora caninum, are unlikely to be the cause of infection of the analyzed fetuses. Taking this into account, the presence of C. fetus in the abomasal fluid samples from two bovine fetuses demonstrated in the present study suggests the possible association of Cfv not only with infertility, but also with cases of bovine abortion, highlighting the importance of investigating unusual causal agents of abortions in sheep and cattle. Overall, an adequate diagnosis is essential for establishing better prevention strategies to avoid the circulation of abortion-related infectious agents in the herds.(AU)

Canine papillomavirus type 16 associated to squamous cell carcinoma in a dog: virological and pathological findings.

Papillomaviruses (PVs) are circular double-stranded DNA virus belonging to Papillomaviridae family. During the infection cycle, PVs translate proteins that can influence cell growth and differentiation, leading to epidermal hyperplasia and papillomas (warts) or malignant neoplasms. Canis familiaris papillomaviruses (CPVs) have been associated with different lesions, such as oral and cutaneous papillomatosis, pigmented plaques, and squamous cell carcinomas (SCCs). Here, we report a clinical case of a mixed bred female dog with pigmented plaques induced by CPV16 (Chipapillomavirus 2) that progressed to in situ and invasive SCCs. Gross and histological findings were characterized, and the lesions were mainly observed in ventral abdominal region and medial face of the limbs. In situ hybridization (ISH) revealed strong nuclear hybridization signals in the neoplastic epithelial cells, as well as in the keratinocytes and koilocytes of the pigmented viral plaques. The full genome of the CPV16 recovered directly from the lesions was characterized, and the phylogenetic relationships were determined. The identification of oncoprotein genes (E5, E6, and E7) by high throughput sequencing (HTS) and their expected domains are suggestive of the malignant transformation by CPV16.

Short-term outcome after appendectomy is related to preoperative delay but not to the time of day of the procedure: A nationwide retrospective cohort study of 9224 patients.

INTRODUCTION: Acute appendicitis is among the most common indications for emergency abdominal surgery. The risk of perforation might increase with a delay in treatment. Therefore, appendicitis is considered a surgical emergency, leading to appendectomies being frequently performed off-hours. However, numerous studies from other medical specialties have shown less favourable outcomes in patients admitted or treated off-hours than in those treated during regular working hours. The purpose of this study was to determine whether the time of day of the procedure and preoperative delay in appendectomy have significant impacts on morbidity and mortality rates. METHODS: All appendectomies recorded in a prospective national quality measurement database (Arbeitsgemeinschaft für Qualitätssicherung in der Chirurgie (AQC)) between 2010 and 2017 were retrospectively analysed. The inclusion criteria were appendicitis (International Classification of Diseases diagnostic codes K35-K37), surgical treatment (appendectomy), and available information on the time of day the appendectomy was performed. We stratified patients into four groups according to the start of the operation-'MORNING' for surgeries started between 7:00 a.m. and 12:59 p.m., 'AFTERNOON' for surgeries started between 1:00 p.m. and 6:59 p.m., 'EVENING' for surgeries started between 7:00 p.m. and 11:59 p.m., and 'NIGHT' for surgeries started between midnight and 6:59 a.m. In a further analysis, we examined differences between patients who underwent surgery on the admission day and those who underwent surgery later. A total of 9224 patients with a mean age of 36 ± 19 years (54% men) were included and further analysed. The occurrence of any complication was the primary outcome, whereas in-hospital mortality was the secondary outcome. Variables were entered into bivariate and multivariate analyses. RESULTS: Of the appendectomies, 38% were performed during the afternoon, 31% in the evening, 18% in the morning, and 13% at night-time. Patients who underwent surgery at night had slightly lower American Society of Anesthesiologists scores, were more often managed as emergency cases (98% of the cases), had fewer comorbidities, and were more often covered by statutory instead of private health insurance than the other patients. Junior attending and resident surgeons performed 88% of all night-time operations. The average duration of surgery was not significantly longer in the night-time group than in the day-time groups. The overall complication rate was 4.7%, ranging from 3.5% in the 'NIGHT' group to 5.0% in the 'AFTERNOON' group. However, the differences between the groups were not significant. The in-hospital mortality rate was 0.12% (n = 11), ranging from 0.082% (n = 1) in the 'NIGHT' group to 0.17% (n = 5) in the 'EVENING' group. The timing of appendectomy was not associated with mortality. However, the rates of complications, in-hospital mortality, and conversion were all significantly higher in patients with a preoperative delay of >24 h. CONCLUSIONS: The time of day of performing an appendectomy does not seem have any significant effect on complication and mortality rates. However, a longer length of preoperative stay significantly increases the risk of complications and mortality. Night-time operations should be preferred over next-day surgery considering the equal perioperative risks observed in this study.

Molecular and pathological characterization of teat papillomatosis in dairy cows in southern Brazil.

Teat papillomatosis is caused by different bovine papillomavirus (BPV) types and is especially important for dairy cows, because it results in severe damage to the health and structure of the mammary gland. This work describes the molecular and pathological aspects of teat papillomatosis in dairy cows in southern Brazil. Samples of teat papillomas were collect from 73 slaughtered dairy cows. Fragments of the lesions were collected in individual pools per animal and subjected to PCR using the FAP primer pair and sequencing of the amplification products. Teats with the remaining lesions were fixed in 10% neutral buffered formalin, routinely processed for histopathology, and stained with hematoxylin and eosin (H&E). Papillomatous lesions were characterized by three macroscopic patterns, namely exophytic (5 [6.9%]), flat (29 [39.7%]), and mixed (39 [53.4%]). Histologically, all samples were identified as squamous papillomas. Partial sequencing of the L1 gene resulted in the detection of 8 classical BPV types (BPVs 4, 6, 7, 8, 9, 10, 11, and 12) in 27 samples, 6 previously reported putative BPV types in 17 samples, and 10 putative new BPV types in 15 samples. Four sequences could not be classified, and 10 were negative in the PCR. There was no correlation between the gross pattern and the BPV type identified, and all the samples were characterized by squamous papillomas under histological examination. However, 24 different BPV types were identified, demonstrating high genetic diversity among BPVs associated with teat papillomatosis in dairy cows in southern Brazil.